Bisphosphonates 'linked with Barretts’ oesophagus'

The US researchers conducted a case-control study among eligible patients scheduled for an elective oesophago-gastro-duodenoscopy (EGD) and a sample of patients eligible for screening colonoscopy recruited from primary care practices over a four-year period. Patients with definitive Barretts’ oesophagus were compared with controls; all underwent an EDG. There were 285 patients with Barretts’ oesophagus, 1,122 endoscopy controls, and 496 primary care controls. The use of oral bisphosphonates was ascertained by reviewing filled prescriptions in pharmacy records. Alendronate and risedronate were the only oral bisphosphonates prescribed. All patients were over the age of 40.

The results

The proportion of cases Barretts’ oesophagus with filled prescription of oral bisphosphonates (4.6%) was greater than in endoscopy controls (1.6%) or primary care controls (2.9%). In the adjusted analysis, oral bisphosphonate use was significantly associated with a 2.33 increased risk of Barretts’ oesophagus, compared with the combined control groups. The association remained significant when Barretts’ oesophagus cases were compared with endoscopy controls only (OR 2.74). The association between bisphosphonates and Barretts’ oesophagus was observed in patients with GERD symptoms (OR 3.29).

What this means for GPs

The researchers note that they found a ‘significant association between oral bisphosphonate use and an increased risk of Barretts’ oesophagus, especially among patients with GERD symptoms’ but advise that ‘additional studies are needed to further examine this association, as it could suggest an increased risk of oesophageal cancer in oral bisphosphonate users’.